Chartbook on Rural Health Care

Adults With Diabetes Who Received Recommended Services

Adults age 40 and over with diagnosed diabetes who received all four recommended services for diabetes in the calendar year, United States, 2012

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2012.
Note: All four recommended services include 2 or more hemoglobin A1c measurements, dilated eye examination, foot examination, and flu shot in the calendar year.

• Importance: Diabetes is one of the leading causes of hospitalization in the United States, with more than 600,000 discharges in 2009 (CDC, 2011). With appropriate and timely ambulatory care, it may be possible to prevent many hospitalizations for diabetes and related complications.
• Overall Rate: In 2012, 26.6% of adults diagnosed with diabetes received all four recommended services for diabetes.
  • The percentage of adults diagnosed with diabetes who received all four recommended services for diabetes was highest in small metropolitan areas (32.6%) and lowest in noncore areas (21.4%).
  • The percentage of adults with diagnosed diabetes who received all four recommended services was 27.2% in large central metropolitan areas, 26.0% in large fringe metropolitan areas, 25.8% in medium metropolitan areas, and 24.7% in micropolitan areas.

Hospital Admissions for Uncontrolled Diabetes

Hospital admissions for uncontrolled diabetes without complications per 100,000 population, age 18 and over, by residence location, 2001-2012

2008 Achievable Benchmark: 5 per 100,000 Population.

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2001-2011 Nationwide Inpatient Sample and 2012 State Inpatient Databases quality analysis file and AHRQ Quality Indicators, version 4.4.
Denominator: U.S. resident population age 18 and over.
Note: For this measure, lower rates are better.

• Importance: Individuals who do not achieve good control of their diabetes may develop symptoms that require correction through hospitalization. Admission rates for uncontrolled diabetes may be reduced by better outpatient treatment and patients’ tighter adherence to diet and medication.
• Trends: From 2001 to 2012, the rate of hospital admissions for uncontrolled diabetes decreased overall and for all residence location groups.
• Groups With Disparities: In almost all years, the rates of hospital admissions for uncontrolled diabetes were higher among residents of noncore, micropolitan, and large central metropolitan areas and lower among residents of medium metropolitan areas compared with residents of large fringe metropolitan areas (suburbs), but these differences were often not statistically significant due to small sample sizes.
• Achievable Benchmark:
  • The 2008 top 4 State achievable benchmark was 5 admissions per 100,000 population age 18 and over. The top 4 States that contributed to the achievable benchmark were Colorado, Hawaii, Utah, and Vermont.
  • At the current rates, residents of noncore and micropolitan (nonmetropolitan) areas should reach the benchmark in about 10 years, sooner than residents of metropolitan areas, whose rates are not decreasing as quickly.

Suicide Deaths

Suicide deaths per 100,000 population, 2008-2011

2008 Achievable Benchmark: 9.0 per 100,000 Population.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System—Mortality, 2008-2011.
Note: The 2009 data include ages 12 and over. Other years included all ages.

• Importance: Suicide may be prevented when its warning signs are detected and treated. Identification of suicidal ideas and plans among individuals being treated for depression is expected to increase with the growing use of standardized screening instruments and electronic medical records.
• Overall Rate: In 2011, the total suicide rate was 14.9 per 100,000 population.
• Trends: From 2008 to 2011, the overall suicide rate and rates for residents of large fringe metropolitan, medium metropolitan, small metropolitan, micropolitan, and noncore areas got worse.
• Groups With Disparities:
  • In 2011, residents of medium and small metropolitan, micropolitan, and noncore areas had higher rates of suicide than residents of large fringe metropolitan areas.
  • Residents of large central metropolitan areas had lower rates than residents of large fringe metropolitan areas.
• Achievable Benchmark:
  • The 2008 top 5 State achievable benchmark was 9.0 per 100,000 population. The top 5 States that contributed to the achievable benchmark were and Connecticut, District of Columbia, Massachusetts, New Jersey, and New York.
  • No group showed progress toward the benchmark.

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